Whistle-Blower Suit Accuses Hospice Company Of Medicare Fraud

A Wisconsin lawsuit alleges that SouthernCare, an Alabama-based hospice company, fraudulently enrolled Madison-area patients in hospice care and charged Medicare for the services. The federal lawsuit was unsealed on September 14th. SouthernCare, based in Birmingham, paid the federal government $24.7 million in January 2009 to settle similar claims in Alabama. Karina Christensen, the former clinical director of SouthernCare’s Madison, Wis. office, filed the new suit in February in U.S. District Court in Wisconsin. It was unsealed after the federal government declined to intervene.

In the new suit, the Plaintiff alleges that SouthernCare charged Medicare for care the company provided to patients who didn’t have terminal illnesses. Medicare, the main payer for hospice care, or comfort care preceding death, requires patients to have six months or less to live as determined by a doctor. The whistle-blower suit is the first known Medicare fraud case against SouthernCare since the $24.7 million settlement, according to Ms. Christensen’s lawyer, Nora Hitchcock Cross of Milwaukee, who also had this to say about the latest suit:

It does appear that the lesson was not learned. We believe this is a nationwide practice, and we’re talking large sums of money.

SouthernCare, a for-profit company with 75 offices in 15 states, opened its Madison office in 2007. It also has an office in Green Bay. The Plaintiff, Ms. Christensen, claims her supervisors encouraged enrollment of patients who weren’t terminally ill and dismissed her complaints that the practice was illegal. The Plaintiff was fired shortly after sending the board of directors and the regional director a letter about her concerns in August 2010. In many cases, the suit alleges, Ms. Christensen didn’t receive medical information about patients until several days after they had been enrolled and Medicare had been billed. The suit also alleges that:

SouthernCare encouraged the practice of admitting and falsely billing for unqualified patients by setting goals based on the number of new admissions and the average daily census of patients.

Examples of a dozen unnamed patients are included. One person admitted as a “cancer patient” was free of cancer according to her medical records, the suit says. Another, listed as having heart disease, “showed no signs or symptoms of heart disease.”